Pursuing Excellence in Healthcare: Preserving America's Academic Medical Centers

332 Pages·2009·2.47 MB·English

by  Arthur M. Feldman

Pursuing
Excellence in
Healthcare
Preserving America’s
Academic Medical Centers
Endorsements
“This is a terrific resource for anyone interested in understanding the
indispensable role of the academic health center. But this is not an
apologia. Dr. Feldman identifies the key problems we need to solve
and the kinds of solutions we must adopt to ensure the excellence
of our essential missions in research, training, and health care going
forward. A book all health care leaders should read and then read
again.”
Michael M.E. Johns, MD
Chancellor, Emory University
“You will not agree with everything that Dr. Feldman writes in
Pursuing Excellence: Preserving America’s Academic Medical
Centers, which is precisely why you should read and debate it.
Scientist, scholar, educator, entrepreneur, and, especially, clinician,
Dr. Feldman has given us a provocative and passionate insider’s view.
It arrives just in time to stimulate our thinking at this moment of
great opportunity.”
Andrew L. Epstein, MD
Managing Director, Navigant Consulting, Inc.
“This is a splendid book that explores the unique role and contri-
butions of academic medical centers in society. Enhanced by the
author’s intimate knowledge of the subject matter, it is well struc-
tured, easy to read and thought provoking. It details the evolution of
academic medical centers from their origins as small, simple enclaves
for medical scholars with altruistic motivations to their current form
as large, complex enterprises that serve as a home for cutting edge
health care, biomedical research and health professional education,
and as an economic engine for the communities they serve.
The author underscores the essential importance of excellence in
health care as a cornerstone for most successful academic medical
centers and explores the synergistic roles of four elements that he
proposes as components or spheres of action of a model for a suc-
cessful academic medical center: structure, research, education and
business. Each is explored in some detail, often benefiting from the
author’s knowledge and personal experience. Always based on fact,
the author’s passion for the subject matter is ever present and makes
this a very interesting book to read. I recommend it for anyone who
wants to know about the elements that have shaped and continue to
influence the structure and functioning of academic medical centers
in the United States. Dr. Feldman is to be congratulated on writing
a very important, timely and remarkably entertaining book.”
Paul K. Whelton, MB, MD, MSc
President and Chief Executive Officer
Loyola University Health System, Loyola University Medical Center
“This comprehensive overview of the academic medical center enter-
prise brings together, in a remarkably coherent fashion, history, eco-
nomics, and politics as they intersect with the traditional academic
missions of education, patient care, and research. It is informative
and perceptive, with substantive insights and recommendations. The
book is a welcome addition to the growing literature in this area.”
Steven A. Wartman, MD, PhD, MACP
President/CEO, Association of Academic Health Centers
“Dr. Feldman has done all of us who care deeply about the future
of academic medical centers a service in presenting the wealth of
facts and thoughtful analysis that he provides in Pursuing Excellence
in Health Care: Preserving America’s Academic Medical Centers.
Whether one agrees with his final recommendations or not, his
arguments are well developed and persuasive, and the important
issues are delineated comprehensively and fairly. I was particularly
struck by his introductory comment that the four C’s that ought
to provide the foundation of our work as physicians—compassion,
confidence, commitment and competence—are in danger of being
replaced by the four A’s that define success in the modern healthcare
marketplace—affability, availability, affordability and accessibility. I
would take this one step further to say that the greatest value of the
academic medical center to society likely resides lies within the four
I’s: imagination, intellect, innovation and idealism. Reading this
book may help us to keep it so.”
R. Sanders Williams, MD
Senior Vice Chancellor for Academic Affairs
Duke University School of Medicine
“Arthur Feldman, MD, PhD, has produced a landmark work, doc-
umenting the plight of the U.S. academic medical center (AMC),
highlighting its importance, and charting a course for securing its
successful future. Dr. Feldman appropriately places clinical care at
the center or the AMC’s mission and insightfully guides the reader
through the labyrinth of interdependencies among the AMC’s
essential clinical, teaching, and research missions. He hones in on
the complexities of structure and business operations, exquisitely
describing how we got where we are, and providing a clear vision
for surviving and thriving in the upcoming challenging era. Dr.
Feldman’s book is a must-read for all stakeholders in the mission of
preserving what is good about US healthcare and fixing all that is
broken about it.”
Marvin A. Konstam, MD
Chief Physician Executive
The CardioVascular Center, Tufts Medical Center
Professor of Medicine, Tufts University School of Medicine
“Art Feldman has done a great service to the world of academic
medicine by conceptually redesigning the “three legged stool” aca-
demic medical center architecture into a thoroughly modern pyra-
mid with academics, business, structure, and research as its base and
outstanding clinical care as the apex. The ramifications for AMC
leadership effectiveness of acknowledging and embracing this bold
revision are profound—as are the accompanying challenges of iden-
tifying, preparing, and sustaining such leaders. Dr. Feldman’s com-
prehensive and insightful perspective on the AMC’s dilemma in our
time not only validates and informs the struggle AMC leaders face
but illuminates potential strategies for their success going forward.
Kudos!”
Stephen Blattner, MD, MBA
Founding Principal of exăgoMD, LLC
Sponsor of the Health Care Leadership Blog
(www.healthcareleadershipblog.com)
Pursuing
Excellence in
Healthcare
Preserving America’s
Academic Medical Centers
Arthur M. Feldman, MD, PhD
Foreword by Edward J. Benz, Jr., MD
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Library of Congress Cataloging‑in‑Publication Data
Feldman, Arthur M. (Arthur Michael), 1949-
Pursuing excellence in healthcare : preserving America’s academic medical centers
/ Arthur M. Feldman.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4398-1657-8 (hardcover : alk. paper)
1. Academic medical centers--United States. I. Title.
[DNLM: 1. Academic Medical Centers--United States. WX 27 AA1 F312p 2010]
RA981.A2F45 2010
362.12--dc22 2009026677
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To my mentors, who passed on to me the traditions of excellence
Kenneth L. Baughman, MD
Michael R. Bristow, MD, PhD
Saul W. Brusilow, MD
Myron L. Weisfeldt, MD

Foreword
Academic medical centers (AMCs) have served a unique and vital role in the
advancement of health both nationally and worldwide. Their uniqueness arises
from the special way that they combine biomedical research, clinical research,
high-quality professional education, and a full array of cutting-edge clinical ser-
vices within one entity. During the roughly 100 years of their existence, they
have become worldwide models for the kind of organizational framework that
best promotes the application of new medical knowledge to improve healthcare.
AMCs have also become the almost exclusive source of highly educated and
qualified physicians, nurses, and allied health professionals in the United States.
Along the way, particularly in the half century since the introduction of
Medicare, AMCs have also become enormously large business enterprises. In
some urban areas, these centers have become the largest nonfederal employer in
the region. As a result of this evolution, AMCs have become something quite a
bit more complicated and embedded in the “real world” of highly competitive
medical care delivery than they were intended to be when first conceived in
the late nineteenth century. Long ago, AMCs ceased to be the small, fraternal
enclave of medical scholars providing virtually free care to the local “charity”
hospitals where they trained the next generation of physicians and scientists.
Most AMCs are now sprawling enterprises employing thousands of faculty and
tens of thousands of workers of all types.
As inherently hybrid, multimission organizations, AMCs make unique con-
tributions to society that should ensure their existence and even prosperity far
into the future. However, the “hybrid” nature of the organizations also threatens
their very existence. As healthcare providers, AMCs compete in an increasingly
Darwinian marketplace with equally large and capable healthcare service organ-
izations that can devote all of their energies and resources to the provision of
services. Even at the high “quaternary care” end, these services are increasingly
commoditized and priced in a reimbursement environment that forces everyone
to operate on razor-thin margins.
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